These authors reviewed the results of 16 patients having humeral head arthroplasty with soft tissue interposition grafting of the glenoid with a minimum follow-up time of 2 years, unless revision surgery was required.
There were 12 male and 4 female patients with a mean age of 36.1 years (range, 14-45 years). Preoperative indications for surgery included glenohumeral arthritis in 11, glenohumeral
chondrolysis in 3, instability arthropathy in 1 and capsulorrhaphy arthropathy after a Bristow procedure in 1.
The humeral head was replaced with a standard Tornier hemiarthroplasty prosthesis or an Arthrosurface humeral head resurfacing implant. Seven glenoids were resurfaced using a GraftJacket acellular, allograft human dermal matrix–based scaffold and 9 with an Achilles tendon allograft.
At a mean follow-up of 60 months, the patients showed improvement in the visual analog scale score for pain from 8.1 to 5.8 and the American Shoulder and Elbow Surgeons score improved from 23.2 to 57.7 (P < .05). However, conversion to a total shoulder arthroplasty was performed in 7 patients (44%) at a mean of 36 months. The authors concluded that because of the limited improvement in patient outcomes and the high revision rate, biologic resurfacing of the glenoid with humeral head resurfacing should be used with caution.
Comment: Young patients with shoulder arthritis present a tough challenge, first of all because they have more complex pathologies, second because they have high expectations and third because the requirement for durability is so much greater. There is no perfect procedure for these folks. In our practice, we considering discussing the possibility of a ream and run procedure with well-motivated, non-smoking, non-depressed young patients who are not on substantial narcotics.
Another point worth making is that we find that a well positioned AP in the plane of the scapula and a true axillary view as shown in a prior post are more useful than x-rays such as those shown below in assessing shoulder pathology before surgery and the glenohumeral anatomy after surgery.
Another point worth making is that we find that a well positioned AP in the plane of the scapula and a true axillary view as shown in a prior post are more useful than x-rays such as those shown below in assessing shoulder pathology before surgery and the glenohumeral anatomy after surgery.
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